Sleep apnea, poor sleep and ED: what the studies show
The short answer
Sleep apnea is linked to ED: across many studies, men with obstructive sleep apnea are more likely to report erection problems, and worse apnea tends to go with worse erectile scores. That is an association, not proof of cause. Treating apnea with CPAP has shown mixed results for erections, so ED and sleep apnea both deserve a clinician's check.
In short: obstructive sleep apnea and erectile dysfunction (ED) show up together far more often than chance would suggest. Several reviews of the research find ED more common in men with sleep apnea, and the National Institutes of Health (NIH) lists sexual dysfunction among the symptoms of sleep apnea. What the studies have not settled is cause: the two share risk factors such as age, weight and blood pressure, and trials of the main apnea treatment, CPAP, have given mixed results for erections. This guide covers what sleep apnea is, what the studies found, how it might affect erections, what treatment trials showed, what poor sleep in general may do, and when to bring it up with a clinician.
Can sleep apnea cause erectile dysfunction?
Sleep apnea is clearly linked to ED, but the research shows an association rather than proof that one causes the other. A 2018 systematic review of 28 observational studies concluded that obstructive sleep apnea “is associated with a higher risk of ED,” and called for better-designed trials and long-term studies to go further (Kellesarian et al., Int J Impot Res 2018). The NIH’s National Heart, Lung, and Blood Institute (NHLBI) includes “sexual dysfunction or decreased libido” in its list of sleep apnea symptoms (NHLBI, Sleep Apnea Symptoms). That is a statement about patterns across many men, not a diagnosis for any one man, and our guide to what ED can signal about your health covers the other conditions that belong in the same conversation.
What is sleep apnea?
Sleep apnea is a common condition in which breathing stops and restarts many times during sleep, which can keep the body from getting enough oxygen. In the most common type, obstructive sleep apnea (OSA), the upper airway becomes blocked again and again during sleep, reducing or stopping airflow (NHLBI, What Is Sleep Apnea?). NHLBI says it is more common in men than women, and that age, obesity, a large neck, tongue or tonsils, alcohol and smoking raise the risk (NHLBI, Causes and Risk Factors). The night-time signs, such as loud snoring, gasping and breathing that stops and starts, are easy to miss: NHLBI notes that you may not know you have them until someone tells you (NHLBI, Sleep Apnea Symptoms).
How common is ED in men with sleep apnea?
ED is common in men with sleep apnea, with the studies below finding it in around half to two-thirds of them. A 2015 review pooling 5 studies found that men with OSA had about 1.8 times the risk of ED (relative risk 1.82), while noting significant differences between the studies (Liu et al., J Sex Med 2015). A Spanish study of 150 men newly diagnosed with OSA found ED in 51% (Pascual et al., PLoS One 2018), and a 2026 review put the figure at 59% to 69% across the studies it included (Pang et al., Int J Impot Res 2026). These figures come from men already diagnosed with sleep apnea, often in hospital sleep units, so the numbers are not a prediction for any one man.
| Source | Who was studied | What it found |
|---|---|---|
| Liu et al. 2015 review | 5 observational studies of men with and without OSA | ED about 1.8 times as likely with OSA; results varied a lot between studies |
| Kellesarian et al. 2018 review | 28 observational studies (19 cross-sectional) | OSA associated with a higher risk of ED; calls for trials and long-term studies |
| Pascual et al. 2018 | 150 men newly diagnosed with OSA in Spain | 51% had ED |
| Pang et al. 2026 review | 7 studies, 594 patients, for the severity analysis | More severe apnea went with lower erectile scores; ED in 59% to 69% of OSA patients |
| Zhou et al. 2026 (UK Biobank) | 155,688 men followed for a median of 11.6 years | Recorded OSA and snoring not linked to new ED; daytime sleepiness was |
How does sleep apnea cause erectile dysfunction?
The honest answer is that researchers have theories rather than a settled mechanism. The 2026 review describes shared pathways that may link the two: repeated drops in oxygen overnight, damage to the lining of blood vessels (endothelial dysfunction), inflammation and reduced nitric oxide, the signal that lets blood vessels in the penis widen (Pang et al., Int J Impot Res 2026). That review found that more severe apnea, measured by the number of breathing pauses and shallow-breathing episodes per hour, went with lower erectile function scores, and that lower overnight oxygen levels did too. A cross-sectional study adds other candidates from the literature: broken-up sleep, less REM sleep, daytime sleepiness and lower testosterone (Cantone et al., Andrologia 2022). The blood vessel route is the same one behind the link between heart disease and ED.
Is the link proven, or just an association?
It is an association. The studies behind it are mostly cross-sectional snapshots, which can show that two conditions travel together but not which came first, and the 2018 review said well-designed controlled trials and long-term studies are still needed (Kellesarian et al., Int J Impot Res 2018). Shared risk factors muddy the picture. The NIH’s list of conditions that can lead to ED includes obesity, high blood pressure and heart disease, which also travel with sleep apnea, though the list does not name sleep apnea itself (NIDDK, Symptoms & Causes of ED). The 2026 review found age to be a significant confounder (Pang et al., Int J Impot Res 2026). Our guide to how to read ED evidence explains why these study designs matter.
A large long-term study cuts both ways. Among 155,688 men in the UK Biobank followed for a median of 11.6 years, men with recorded sleep apnea or snoring were not significantly more likely to be diagnosed with ED later. Men who reported frequent daytime sleepiness (hazard ratio 2.05) or difficulty getting up in the morning (1.85) were, after adjusting for other factors. The authors point out that only about 1% of the men had a recorded sleep apnea diagnosis, far below what sleep studies find, so many cases were probably missed (Zhou et al., Sci Rep 2026).
Does treating sleep apnea with CPAP help ED?
The evidence is mixed, and the best summary is uncertain. A 2021 Cochrane review of 6 randomized trials (315 men, all testing CPAP) rated the evidence very low certainty and concluded, “we are uncertain about the effectiveness” of CPAP for improving ED compared with no CPAP. In 3 trials that compared CPAP with sildenafil, sildenafil “may slightly improve erectile function at 12 weeks” (Barbosa et al., Cochrane Database Syst Rev 2021). Individual trials show why. In the Spanish trial, men on CPAP for 3 months improved on erectile function, but only the change in sexual satisfaction was clearly different from the untreated group; the trial stopped early and was not blinded (Pascual et al., PLoS One 2018). In an Australian trial of 61 men with moderate to severe OSA and ED, CPAP increased sleep-related erections and overall sexual satisfaction but did not change erectile function scores against a sham device, although men who used CPAP consistently did improve (Melehan et al., J Clin Endocrinol Metab 2018).
| Study | Design | Erectile function result |
|---|---|---|
| Cochrane review 2021 | 6 randomized trials, 315 men | Effect of CPAP vs no CPAP uncertain; very low-certainty evidence |
| Cochrane review 2021 | 3 trials of CPAP vs sildenafil, 152 men | Sildenafil may slightly improve erectile function at 12 weeks |
| Pascual et al. 2018 | Open-label trial, 3 months of CPAP vs none | Improved, but the difference from the control group was borderline |
| Melehan et al. 2018 | CPAP vs sham CPAP for 12 weeks, 61 men | No change overall; improvement in men who used CPAP consistently |
Sleep apnea is worth treating whatever it does for erections. NHLBI says untreated sleep apnea raises the risk of stroke, heart attack and other serious problems, and lists breathing machines, oral devices, lifestyle changes and in some cases surgery as treatments (NHLBI, What Is Sleep Apnea?; NHLBI, Sleep Apnea Treatment). The Spanish trial’s authors suggested that CPAP may need to be combined with other options, such as weight loss or ED medicine, depending on how severe the ED is.
Can ED pills be used if you have sleep apnea?
That is a question for the prescriber, and one trial offers some reassurance. The Australian trial noted a concern that PDE5 inhibitors, the class that includes sildenafil and vardenafil, might worsen sleep apnea. In that trial, vardenafil did not worsen sleep-disordered breathing. It did not change the main erectile function score, but it improved some other aspects of sexual function and treatment satisfaction (Melehan et al., J Clin Endocrinol Metab 2018). One trial is not a general rule, and the choice of medicine and amount belongs to the prescriber who knows your full health picture. Tell them about sleep apnea and anything else you take, including sleep or sedative medicines, which NIDDK lists among the medicines that can have ED as a side effect (NIDDK, Symptoms & Causes of ED).
Can poor sleep without sleep apnea affect erections?
Possibly, but the evidence is thinner. In the UK Biobank study, insomnia symptoms were not linked to later ED, while frequent daytime sleepiness and difficulty waking were (Zhou et al., Sci Rep 2026). Hormones are one suggested route. In a small study of 10 healthy young men, one week of sleep limited to 5 hours a night lowered daytime testosterone by 10% to 15%; the authors noted that most daily testosterone release in men happens during sleep. That study measured hormones and vigor, not erections (Leproult and Van Cauter, JAMA 2011). Low testosterone is one possible contributor to ED among many, which our page on low testosterone and ED puts in proportion.
Do sleep-related erections tell you anything?
They are one thing researchers measure, not a home test. The Australian trial found that CPAP increased how often sleep-related erections happened in men with sleep apnea, even though erectile function scores did not change overall (Melehan et al., J Clin Endocrinol Metab 2018). Our page on morning erections explains what their presence or absence can and cannot tell you.
When to talk to a clinician
Bring up ED and your sleep in the same appointment. Mention loud snoring, gasping or pauses in breathing that a partner has noticed, daytime sleepiness, headaches or waking often at night to urinate, which NHLBI lists as signs of sleep apnea. Your clinician may suggest a sleep study to check for it. Do not stop or start any medicine on your own, and seek care right away for chest pain or an erection lasting longer than 4 hours.
The bottom line
Obstructive sleep apnea and ED often occur together, and more severe apnea tends to go with worse erectile function, but the link is an association with shared risk factors, not proven cause. Treating sleep apnea with CPAP has given mixed and uncertain results for erections, while low-certainty evidence suggests sildenafil may do slightly better than CPAP in head-to-head trials. Sleep apnea matters for the heart and brain in its own right, so if you have ED and the signs of sleep apnea, ask about both. The right next step is a checkup, not a guess.
Sources
Every clinical statement on this page traces to a primary or guideline source:
- NIH NHLBI, What Is Sleep Apnea? (last updated January 9, 2025): definition; obstructive sleep apnea as the most common type; diagnosis by sleep study; untreated sleep apnea raises the risk of stroke, heart attack and other serious problems.
- NIH NHLBI, Sleep Apnea Symptoms (last updated January 9, 2025): snoring, gasping, breathing that stops and starts, daytime sleepiness, headache, waking at night to urinate, and “sexual dysfunction or decreased libido”; you may not know you have symptoms until someone tells you.
- NIH NHLBI, Sleep Apnea Causes and Risk Factors (last updated January 9, 2025): more common in men; age, obesity, airway features, alcohol and smoking as risk factors.
- NIH NHLBI, Sleep Apnea Treatment (last updated January 9, 2025): lifestyle changes, positive airway pressure machines, oral devices and surgery.
- NIH NIDDK, Symptoms & Causes of Erectile Dysfunction (last reviewed October 2024): conditions that can lead to ED, including obesity, high blood pressure and heart disease; sedatives among the medicines that can cause ED.
- Liu L, et al. Sexual Dysfunction in Patients with Obstructive Sleep Apnea: A Systematic Review and Meta-Analysis (J Sex Med, 2015): pooled relative risk of ED 1.82 from 5 observational studies, with significant heterogeneity.
- Kellesarian SV, et al. Association between obstructive sleep apnea and erectile dysfunction: a systematic review and meta-analysis (Int J Impot Res, 2018): 28 observational studies; OSA associated with a higher risk of ED; trials and long-term studies needed.
- Pang KH, et al. The association between obstructive sleep apnoea and erectile dysfunction: a systematic review and meta-analysis (Int J Impot Res, 2026): apnea severity and oxygen levels correlated with erectile scores; ED in 59% to 69% of OSA patients; age as a confounder; proposed shared pathways; high heterogeneity.
- Zhou H, et al. Association between obstructive sleep apnea and male sexual dysfunction: a prospective cohort study based on 155,688 participants from the UK Biobank (Sci Rep, 2026): recorded OSA and snoring not significantly linked to new ED; daytime sleepiness and hard waking linked; insomnia symptoms not linked; likely underdiagnosis of OSA.
- Cantone E, et al. The relationship between obstructive sleep apnoea and erectile dysfunction: An underdiagnosed link? (Andrologia, 2022): candidate mechanisms including oxidative stress, nitric oxide, sleep fragmentation, reduced REM sleep and lower testosterone.
- Pascual M, et al. Erectile dysfunction in obstructive sleep apnea patients: A randomized trial on the effects of CPAP (PLoS One, 2018): 51% ED prevalence in 150 newly diagnosed men; 3-month CPAP trial results and limitations.
- Melehan KL, et al. Randomized Trial of CPAP and Vardenafil on Erectile and Arterial Function in Men With Obstructive Sleep Apnea and Erectile Dysfunction (J Clin Endocrinol Metab, 2018): CPAP vs sham CPAP and vardenafil vs placebo in 61 men; sleep-related erections, satisfaction, adherence, and no change in erectile function score but no worsening of sleep-disordered breathing with vardenafil.
- Barbosa FT, et al. Non-invasive positive airway pressure therapy for improving erectile dysfunction in men with obstructive sleep apnoea (Cochrane Database Syst Rev, 2021): 6 trials, 315 men; uncertain effect of CPAP; sildenafil may slightly improve erectile function compared with CPAP at 12 weeks (low-certainty evidence).
- Leproult R, Van Cauter E. Effect of 1 Week of Sleep Restriction on Testosterone Levels in Young Healthy Men (JAMA, 2011): daytime testosterone 10% to 15% lower after a week of restricted sleep in 10 men.
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